Coitus interruptus: Is it rare among teens?
With the wide array of birth control options available today, are adolescents still relying on coitus interruptus? Results of a 2009 study indicate that clinicians should not consider use of contraceptive withdrawal infrequent among teens.1
Withdrawal has been used as contraceptive method for hundreds of years and continues to be utilized today in the adolescent population, despite its rare acknowledgement and high failure rate, says Jennifer Woods, MD, MS, FAAP, assistant professor of pediatrics in the Section of Adolescent Medicine at the University of Arkansas for Medical Sciences in Little Rock and lead author of the current research. Study results indicate the method is commonly used alone or when other methods may be considered the primary method, she states.
"Clinicians should be aware of this usage in order to investigate usage patterns and the context of usage in short-/long-term sexual relationships as well as in prevention of STIs [sexually transmitted infections] and pregnancy," states Woods.
Use of withdrawal has grown over the 20 years from 1982 to 2002, according to a national survey of women ages 15-44.2 The proportion who had ever had a partner who used withdrawal increased from 25% in 1982 to 56% in 2002.2
To perform the current study, investigators enrolled 387 sexually active adolescent females ages 14-17 from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs.
The outcome variable was defined as withdrawal use during the previous 12 weeks. Predictor variables included 19 individual, family, and partner variables. All models additionally controlled for any current hormonal use, current condom use, and past withdrawal use.
Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% of interviews with young women using hormonal methods, in 32.4% of the interviews with those using condoms, and in 4.7% of interviews with no method.
Researchers found that current withdrawal use was more likely with those who reported a more diverse sexual repertoire, more sexual partners in the past three months, higher sexual control, lower perceived STI risk, higher sexual self-efficacy, lower sexual coercion, higher condom negativity, living with a boyfriend, and lower family sexual health support.1
Contraceptive Technology defines coitus interruptus as the practice of withdrawing the penis from the vagina and away from external genital organs of women before ejaculation, with the intention of avoiding pregnancy.3 Prevalence rates vary from 9% to 48% among teens, depending on how withdrawal is measured (used at last sex occasion or regular use).4-6
Determining the efficacy rates for withdrawal is difficult. Contraceptive Technology estimates the probability of pregnancy among perfect users at about 4% in the first year of use; among typical users the probability of pregnancy rises to about 27% in the initial year of use.3
As a method of contraception, withdrawal has its advantages in that it costs nothing, requires no devices, involves no chemicals, and is available in any situation. "I have long been an advocate of making sure that we do not tell people that withdrawal doesn't work. I include it in all my general contraception talks," says Susan Wysocki, RNC, NP, president and CEO of the Washington, DC-based National Association of Nurse Practitioners in Women's Health. "It is the one method you never leave home without."
In addition, when combined with other methods, such as female barrier methods, it is intuitive that withdrawal would increase the effectiveness of those methods, Wysocki notes.
Despite its advantages, withdrawal is unforgiving of incorrect or inconsistent use, which leads to the heightened probability of pregnancy among typical users. Also, withdrawal does not completely protect couples from exposure to STIs, because not all pathogens are limited to seminal fluid.3 For example, surface lesions from herpes genitalis or human papillomavirus might be actively infective.3
Be sure that those who report use of withdrawal as a contraceptive method are provided emergency contraception.
References
- Woods JL, Hensel DJ, Fortenberry JD. Contraceptive withdrawal in adolescents: A complex picture of usage. J Ped Adolesc Gynecol 2009; 22:233-237.
- Mosher WD, Martinez GM, Chandra A, et al. Use of contraception and use of family planning services in the United States: 1982-2002. Adv Data 2004; 350:1-36.
- Kowal D. "Coitus Interruptus (Withdrawal)." In: Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology: 19th revised edition. New York City: Ardent Media; 2007.
- Everett SA, Warren CW, Santelli JS, et al. Use of birth control pills, condoms, and withdrawal among U.S. high school students. J Adolesc Health 2000; 27:112–118.
- Hoff T, Greene L, Davis J. National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes, and Experiences. Henry J. Kaiser Foundation; 2003.
- Horner J, Salazar LF, Romer D, et al. Withdrawal (coitus interruptus) as a sexual risk reduction strategy: Perspectives from African-American adolescents. Arch Sex Behav 2008; accessed at www.springerlink.com/content.
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